This page commemorates the 80th anniversary of the school's tradition and 30 years of development.University of Social Sciences and Humanities
VIETNAM NATIONAL UNIVERSITY OF HANOI
UNIVERSITY OF SCIENCESOCIETY AND HUMANITIES
Le Thi Nhung
CASE MANAGEMENT FOR PERSONS WITH DISABILITIES IN THE COMMUNITY IN HO CHI MINH CITY
Major: Social Work
Code: Pilot Training Program
ABSTRACT OF THE DOCTORAL THESIS IN SOCIAL WORK
Hanoi – 2020
Scientific supervisor: Assoc. Prof. Dr. Bui Thi Xuan Mai
Assoc. Prof. Dr. Nguyen Thi Thai Lan
Counter-argument 1: ...................................................................
Counter-argument 2:.....................................................................
The dissertation will be defended before the Doctoral Dissertation Examination Board meeting at...
At ............ o'clock, on the......... day of............. month of........... year...........
For more details about the thesis, please visit:
- National Library of Vietnam
- Information and Library Center, Vietnam National University, Hanoi
INTRODUCTION
1. Reasons for choosing the topic
Among vulnerable groups, the number of people with disabilities accounts for a large proportion and is rapidly increasing both globally and in Vietnam. The community of people with disabilities (PWDs) numbers up to one billion, accounting for more than 15.3% of the world's population [WHO, WB, 2011, p. 29], of which 80% live in developing countries [United Nations, 2006]. According to the national survey on PWDs by the General Statistics Office, Vietnam has more than 7% of its population aged 2 years and older – approximately more than 6.2 million people – who are people with disabilities [General Statistics Office, 2018, p. 15]. The total number of people with disabilities in Ho Chi Minh City as of July 2019 was 62,554 [Ho Chi Minh City Department of Labour, Invalids and Social Affairs, 2019]. People with disabilities are among the most vulnerable and disadvantaged groups, facing numerous difficulties in all aspects of life [WHO, 2010, p. 9].
Over the years, the Party and the State have paid more attention to people with disabilities in order to create the best conditions for them to gradually develop comprehensively and integrate into the community. In 2019, three amended and supplemented laws were passed, incorporating regulations to protect the rights of people with disabilities, along with many sub-laws of the Government, ministries, departments, and especially the Central Committee of the Party with Directive No. 39-CT/TW of the Secretariat on strengthening the Party's leadership over the work of people with disabilities [Lan Phuong, 2019].
However, a relatively small number of people with disabilities access and benefit from state policies. Nationwide, only 1.3 million people with disabilities have been issued disability certificates [Ministry of Labour, Invalids and Social Affairs, 2016], meaning a rather modest percentage of people with disabilities are officially receiving preferential policies from the state. In Ho Chi Minh City, those (about 1% of the total number of people with disabilities) living in social welfare facilities have relatively full access to state support policies and programs, but overall, the level remains low. In another study, in the provinces, only 20% of respondents had a need for centralized care and support, meaning that the majority of people with disabilities wish to live in the community and support themselves [Department of Social Protection, Institute of Labour and Social Sciences, 2012]. The majority of people with disabilities live in the community, especially those who have not been officially recognized as people with disabilities, and do not have many opportunities to access state support policies or professional services in the community. The need for assistance is quite large, reaching nearly 100% [Department of Social Protection, Institute of Labor and Social Sciences, 2012].
Global experience shows that social work plays a crucial role in assisting vulnerable groups in society in general and people with disabilities in particular. Based on the fundamental values of the profession and adhering to ethical guidelines, social workers use their knowledge and skills to perform various roles and tasks for individual, family, and community cases [IFSW, IASSW, 2014]. In social work, case management (CMS) is one of the important and common practices used in assisting people with disabilities in community-based rehabilitation at the individual level, helping them access social policies, enhance independent living, increase capacity, and integrate into society. CMS serves clients with diverse needs and a comprehensive package of services [Rose & Moore, 1995], helping clients receive the best care and save costs [CMSA, 2016, p. 87]. When funding for education, healthcare, housing, and social services is limited, service coordination (referral) is employed as a strategy to improve service quality and outcomes while potentially reducing costs [Brown, 2009; Centers for Medicare & Medicaid Services, 2011].
After 10 years, the Vietnamese Government's Project 32 on the development of social work professions for the period 2010-2020 has achieved many initial successes in promoting the role of social work to address social problems and assist vulnerable groups, including people with disabilities. However, the management of social welfare for people with disabilities is still quite new in Vietnam. The Ministry of Labour, Invalids and Social Affairs has initially standardized and guided the management of social welfare according to Circular No. 01/2015/TT-BLDTBXH dated January 6, 2015. This management is initially applied in some state-owned facilities. The management of social welfare for people with disabilities only meets the minimum needs in the care, education, and rehabilitation of people with disabilities. Some non-governmental social welfare facilities have taken steps to approach this, although not yet officially called "management of social welfare," but they face other regulatory obstacles. In Ho Chi Minh City, with a large number of people with disabilities living primarily in the community, they rely heavily on community support, which necessitates effective case management to ensure access to services and assistance. To date, case management has not been widely developed in the community due to a lack of professional staff, underutilization of local resources, and limited awareness among people with disabilities, their families, and the community regarding their rights. The role of social work in case management is also unclear and lacks professionalism. There are very few studies and assessments of evidence-based research on case management for people with disabilities in the community.
Based on the reasons mentioned above, the author chose to research "Case management for people with disabilities in the community in Ho Chi Minh City."
2. Research Objectives and Tasks
Research objectives
This thesis aims to assess the current state of case management for people with disabilities in the community, analyze influencing factors, and propose solutions to promote the professionalization of case management for people with disabilities in the community.
Research task
3. Research subjects, objects, and scope
Research subjectsCase management for people with disabilities in the community.
Research subjects:
- Staff members managing patient care for people with disabilities conduct a self-assessment as the implementers.
- People with disabilities and their family members/primary caregivers.
- Leadership and management of social assistance facilities
- Leaders and managers at all levels within the Ministry of Labour, Invalids and Social Affairs.
Scope of research
Scope ofContent
Based on ecological systems theory, social role theory, and a community-based rehabilitation approach, this study focuses on researching case management in social work, specifically the performance of roles, processes, and tasks of case managers and some factors that strongly influence case management for people with disabilities in the community.
Scoperegarding the research subject
The survey participants included officials, staff, and collaborators managing people with disabilities at commune/ward People's Committees, facilities, centers, and organizations assisting people with disabilities in the community. In addition, people with disabilities participating in in-depth interviews included those with mobility and visual disabilities aged 18 to 60 years old. For children with autism, a family representative/primary caregiver also answered in-depth interviews. Stakeholders included leaders of support centers/facilities, local authorities, ministerial-level authorities, the Department of Labor, War Invalids and Social Affairs, and officials in charge of Labor, War Invalids and Social Affairs at the district/county level.
Spatial scopen:The study was conducted in 23 out of 24 districts/counties in Ho Chi Minh City.
Time range:From 2015 to 2020
4.Research question
5. Hypothesisstudy
5.1. The implementation of case management for people with disabilities in the community is still quite limited and not yet professional.
5.2. Community health care staff face several difficulties and challenges in implementing community health care management for people with disabilities in the community.
5.3. Several factors strongly influence case management for people with disabilities in the community.
5.4. Training to enhance the capacity of case management staff is one of the solutions to improve case management for people with disabilities in the community.
6. Meaningand the new contributions of the Thesis
In theory:The research findings of this thesis provide a theoretical framework for case management, encompassing its characteristic features, roles, processes, and the tasks of case managers working with people with disabilities in the community from a social work perspective. These conceptual tools contribute to building theories that strengthen case management as an effective social work practice when working with people with disabilities. The research also serves as a reference for future studies on case management in social work.
In practical terms:The practical research results of this thesis help managers and staff identify and recognize the roles, processes, and specific tasks for implementing community-based management of people with disabilities in the community according to the core principles and values of social work; simultaneously, it examines the practical self-assessment and client feedback of staff in implementation, the barriers and difficulties in community-based management of people with disabilities, and explores flexible and effective implementation methods at the local level.
In terms of training:The theoretical framework and practical research results help training institutions orient their training towards in-depth training in community-based health care management for people with disabilities. Simultaneously, they identify actual needs and professional gaps among practitioners to design and organize more appropriate training and capacity-building programs for health care management staff who are currently working with or plan to work with people with disabilities.
In terms of policy:Based on international experience and the current implementation of policies, programs, and services at the local level, this dissertation provides policymakers with a scientific basis for developing and adjusting policies to better support people with disabilities in the community.
Thesis Structure
Besides the Introduction, Conclusion and Recommendations, References, and Appendix, the thesis content is presented in 4 chapters: Overview of the research problem; Theoretical basis and research methods; Current situation of community-based health care management for people with disabilities in Ho Chi Minh City: Solutions for training and capacity building for the team implementing health care management for people with disabilities.
MAIN CONTENT
1. OVERVIEW OF THE RESEARCH PROBLEM
1.1. Studies on case management and case management in social work
Case management is applied worldwide, not only in social work but also in other fields. From a social work perspective, case management was first studied as a method of assistance focused on individuals [Richmond, 1917] through individual assessments of poverty status, coordination activities, networking, and registration. In Vietnam, several studies supported by international organizations have piloted case management in assisting certain target groups such as abused children, children in difficult circumstances (affected by HIV/AIDS, poor families), or drug users. These studies have shown suitability and have modeled the organizational structure of the implementing team, the methods of organizing intervention activities, and assistance services in the specific context of Vietnam. However, some gaps exist in research evaluating practical implementation at the local level, especially in the field of people with disabilities.
1.2. Studies on the roles of case management with people with disabilities in the community
Theoretical and practical studies on case management worldwide show that case management plays a crucial role and is a social work practice that yields positive results in assisting people with disabilities. Furthermore, studies in various countries have clarified and affirmed the role of professionally trained case management staff in teams and collaborative groups as coordinators, connectors, referral agents, resource mobilizers, facilitators, and providers of direct services in counseling, education, and advocacy. However, there are very few practical studies in Vietnam on the position and role of case management with people with disabilities in general, and the specific roles of case management staff in assisting people with disabilities in the community in particular.
1.3. Studies on the process and tasks of case management with people with disabilities in the community.
Several studies have addressed the process and tasks of community health care (CHL) for people with disabilities, emphasizing needs assessment, care planning, assistance, and monitoring/evaluation. In the Vietnamese context, some research reflects the need for CHL tasks to be carried out within a social work process. However, even globally, there is a lack of practical studies evaluating the specific processes and tasks of CHL staff working with people with disabilities in the community. Studies in Vietnam also only focus on providing theoretical foundations.
1.4Studies on models of support for people with disabilities in the community.
Studies worldwide and in Vietnam show that there are several main models for assisting people with disabilities, including: spiritual models, medical models, social models, and rights-based models. Regarding research on community-based support models for people with disabilities, three main groups of models and approaches stand out: standard community-based care models, comprehensive intensive care models, and community-based rehabilitation models. Among these, the community-based rehabilitation model demonstrates superiority, progress, and represents a global trend in assisting people with disabilities.
1.5. Studies on factors influencing case management for people with disabilities in the community.
Several domestic and international studies have identified factors influencing the management of disability services for people with disabilities, ranging from the perspective of service providers (specifically, professional qualifications, knowledge, and skills); from the perspective of people with disabilities (disability characteristics, individual effort, client motivation, and perseverance); from the perspective of family and community (attitudes and participation as support resources); from the perspective of service providers (infrastructure capacity, network capabilities, and leadership awareness); and from the policy system (whether disability issues receive adequate attention and support). However, there are relatively few studies on the factors influencing the management of disability services for people with disabilities within the community context, and the approach tends to focus on negative impacts rather than positive ones.
CHAPTER 2: THEORETICAL FOUNDATION AND RESEARCH METHODOLOGY
2.1. Concepts related to the research problem
2.1.1.People with disabilities
This section of the dissertation addresses the concept of disability, the physical, psychological, emotional, and social characteristics of people with disabilities, the causes from a medical perspective, the physical and social environmental barriers leading to disability, and the need for assistance to meet basic needs.
"A person with a disability is someone who has a defect in one or more body parts or a functional impairment that manifests as a disability, making it difficult for them to work, live, study, and participate in social life." [National Assembly of the Socialist Republic of Vietnam, 12th Legislature, 2010]
2.1.2.Case management in social work
In social work, the management of services is understood as a process of planning, seeking, mobilizing, and monitoring services provided by social services, healthcare organizations, and various personnel to a client [NASW, 2013, p. 13].
Case management involves objectives, characteristics, processes, and tasks, as well as setting professional competency requirements for those performing it.
2.1.3. Case management for people with disabilities in the community
Concept:Case management with persons with disabilities in the community is a process of performing social work tasks based on building therapeutic professional relationships, gathering information, assessing needs and strengths, prioritizing assistance to provide, connect, coordinate, and mobilize services and assistance in the community with the participation of persons with disabilities and the community system, in order to maximize the improvement of their condition and functional abilities, leading to their integration into the community.
Target:The Human Resource Management (HRM) program aims at key objectives in supporting people with disabilities in the community to: i) access necessary information, services, resources, and appropriate, effective, and timely assistance; and ii) maximize participation and self-determination.
Ccharacteristics:The services are client-centered; the occupational therapy relationship between staff and clients is fundamental; people in the environment are central; they are based on strengths; teamwork is involved; and interventions are at the micro, meso, and macro levels.
ProcessIt consists of 6 steps: Step 1 - Receiving the case and building a relationship with the person with disabilities; Step 2 - Gathering information and assessing the needs of the person with disabilities; Step 3 - Developing a care and assistance plan for the person with disabilities; 4 - Implementing the care and assistance plan for the person with disabilities; Step 5 - Monitoring, supervising, and evaluating services and assistance; Step 6 - Concluding and following up after the case.
Main tasksThe responsibilities of a case management staff member include: Receiving cases and establishing occupational therapy relationships with people with disabilities; Gathering information and assessing assistance priorities, strengths, and barriers of people with disabilities; Developing care and assistance plans for people with disabilities; Implementing care and assistance plans for people with disabilities; Monitoring, supervising, and evaluating services and assistance; Concluding and following up after the case; and related administrative tasks.
TheroleThe core of the HR management staff includes: connecting, coordinating, mobilizing resources, and facilitating. In addition, there are other roles such as consulting, educating, and advocating.
Cprofessional competency requirements ofManagement staff
Community-based disability management staff are understood to be individuals who work directly with people with disabilities in the community and perform specialized tasks in disability management.
The requirements include: specialized knowledge related to community-based health management for people with disabilities, knowledge of the tasks and processes of community-based health management for people with disabilities, skills in community-based health management for people with disabilities, and professional ethics in community-based health management for people with disabilities.
2.1.4. Factors affecting the management of relationships with people with disabilities in the community.
The groups of influencing factors that were the focus of the research include:
ButProfessional competence of the project management staff: Possess professional social work qualifications; Have knowledge related to managing relationships with people with disabilities; Have skills in managing relationships with people with disabilities; Adhere to professional ethics and principles in managing relationships with people with disabilities; Have a good understanding of people with disabilities.
- Strengths and abilities of people with disabilities:Understanding one's rights; Identifying one's strengths; Having willpower and motivation; Actively participating in collaboration.
- Awareness and involvement of family and community:i) From the family's perspective: Understanding the rights of persons with disabilities and being responsible towards them; Actively participating and cooperating with staff; Having the capacity to care for and assist persons with disabilities at home; Understanding policies, laws, programs, and resources for assistance; ii) From the community's perspective: Understanding the rights of persons with disabilities; Actively fulfilling responsibilities towards persons with disabilities; Actively participating as a resource for assistance; Creating conditions for persons with disabilities to participate in community life.
- Legal policies:Comprehensive welfare policies for the implementation team; adequate support policies for people with disabilities; diverse programs and services tailored to the needs of people with disabilities; specific policies defining the position, role, responsibilities, and coordination mechanisms of the implementation team; specific guidance and support tools; penalties and incentives for the implementation team's service delivery.
- Support facilities and unitsi) On the leadership side: Leadership awareness and concern include: Understanding and responsibility in implementing the rights of persons with disabilities; Understanding of disability management; Prioritizing the needs of persons with disabilities; Commitment in directing, organizing, implementing, and regularly evaluating disability management; ii) Service capacity and staff: Sufficient staff professionally trained in disability management; Capacity for collaboration and referral networks; Capacity to mobilize local resources.
2.2. Theories used in the topic
Theories, including two (ecological systems theory and social role theory) and one approach (community-based rehabilitation), were applied in developing conceptual tools for community-based rehabilitation with people with disabilities in the Vietnamese context, as well as in the research framework of the dissertation.
2.3. Methods of information collection and processing
The thesis utilized a combination of quantitative and qualitative research methods based on both primary and secondary data sources, including methods for researching and synthesizing available documents, expert opinion surveys, questionnaire surveys, in-depth interviews, focus group discussions, impact experiments, and case studies. The data and information obtained were processed using various methods; quantitative data and information were processed using Excel and SPSS software, while qualitative data and information from in-depth interviews and focus group discussions were processed by coding topics relevant to the study.
The main data collection methods include: questionnaire surveys, in-depth interviews, focus group discussions, impact experiments, and case studies.
Questionnaire survey method
The questionnaire was administered to community health management officers/staff at the People's Committee, public and private institutions that manage community health for people with disabilities in the community.
Step 1 - Conduct a pilot investigationThe questionnaire was piloted and analyzed with 84 questionnaires that met the analysis criteria. The reliability results for the scales in the questionnaire showed Cronbach's Alpha coefficients ranging from 0.674 to 0.804.
Step 2 - Design the questionnaire
Main content of the questionnaire:The questionnaire is structured into four sections: general information on occupation and demographics; current status of performing roles, tasks, and activities in the process of managing and educating people with disabilities; training needs for capacity building; and proposed solutions.
Scale:The survey questionnaire was designed with Likert scales with 5 levels (Vagias, Wade M., 2006) on the level of agreement, level of implementation, level of impact, and level of necessity.
Step 3 - Select survey sample
Size of the sampleBased on the requirements of Exploratory Factor Analysis (EFA):n = 5 xm(m is the total number of observed variables, expressed as the number of questions in the model) [Comrey, 1973; Roger, 2006]. With m = 30, the required sample size =150.
Choose a snowball design.The list is compiled from diverse sources, including recommendations from state management agencies, social work networks, leaders of social assistance facilities working with people with disabilities, students and alumni of the University of Labour and Social Affairs (Campus II) who are also officials and staff in local areas, etc. A survey is then conducted, including subsequent individuals based on recommendations from previous ones.
Step 4 - Execution:Online surveys and questionnaire surveys.
The total number of ballots eligible for analysis is374The questionnaire meets the sample size requirements for a statistically significant sociological survey.
Some characteristics of the research subject (N = 374):
- Type of workplace (A1): Department under the People's Committee (72.5%), Public unit (18.4%), Non-public unit (9.1%)
- Area (A2): 23/24 districts
- Current job position (A3): Social work collaborator (29.7%), social work/social staff (34.5%), labor, invalids and social affairs staff (33.2%), other jobs (coordinator, project staff, homeroom teacher, etc., accounting for 2.7%)
- Expertise in Social Work (A4): None (31.8%), have taken short courses (39%), have elementary/professional certificate level (4.3%), have intermediate level (12.3%), have university level (11.8%), have postgraduate level (0.8%)
- Trained in Management and Administration (A5): No (62.3%), completed a course of less than 1 week (14.2%), completed a course of 1-2 weeks (7.5%), completed a course of 3-4 weeks (9.6%), have a basic level/professional certificate (6.4%).
- Managing multiple teams or taking on other responsibilities: Yes (85.6%), No (14.4%)
- Number of people with disabilities under management: Under 10 people (24.6%), 10-20 people (3.5%), 21-30 people (16.8%), 31-40 people (16.6%), over 50 people (38.5%).
In-depth interview method
To analyze, explain, supplement, or compare survey results, questionnaires and in-depth interviews were conducted with four relevant target groups: Social assistance staff (6 people); people with disabilities (visually impaired, mobility impaired, and autistic) and family members/primary caregivers (8 people); management staff at all levels in the Ministry of Labour, Invalids and Social Affairs and local authorities (4 people); and leaders and managers of social assistance facilities (4 people).
Method of implementation:The staff members involved in the survey were selected based on the survey results to gather more in-depth information. Those interviewed, representing each target group, were chosen to be representative of the district/county. The interview process was conducted with the consent and voluntary participation of the interviewees, who provided written notes and audio recordings. Interviewers used a guide (Appendix of sample questionnaires No. 02, 03, 04, 05 for each target group) to conduct the interviews. In addition, smaller questions were asked, or the questioning method and number of questions were adjusted to explore the content and follow the interviewee's progress.
Group discussion
Following the analysis of the preliminary survey results, group discussions were conducted with case management staff who had also participated in the survey to further analyze and explain the current state of case management implementation for people with disabilities in the community. Number of groups: 4 groups (each group consisting of 6-8 case management staff, totaling 29 people); Discussion time: 50 minutes; Topic: Advantages, difficulties, and obstacles in the process of implementing case management for people with disabilities in the local community and proposed solutions to overcome them.
Method of implementation:The members are individuals who have previously participated in answering the questionnaire. The researcher acts as an observer, recording the progress. Each group has a facilitator (who has received prior training) to guide and support the group's discussion.
Impact experiment
Based on the results of the training needs survey, the study conducted a capacity-building training course for staff and personnel involved in managing and assisting people with disabilities in the community.
Activity 1: Organize intensive training courses on case management for people with disabilities in the community.(10 sessions, 4 hours each)
Number of participants:30 officials and staff members work with people with disabilities at units under the Ward People's Committee, public units, and private units.
Content:The training course focuses on four thematic groups related to community-based health management for people with disabilities, selecting the most important and core content from the body of specialized knowledge, processes, skills, professional ethics, and principles for implementing community-based health management for people with disabilities.
Methods for measuring impact:Participants were surveyed about their level of understanding and confidence in practicing the skills before and after the training, using a survey questionnaire that remained unchanged in content.
Activity 2: Post-training guidance/supervision((6 months)
Form:On-site guidance, remote exchange and consultation of expertise.
Quantity:Two people (one official at the Ward People's Committee, one staff member at the social assistance facility). Both staff members participate in community-based disability management activities for people with disabilities.
Methods for measuring impact:Observe case studies on administrative tasks such as record keeping, archiving, and file management, as well as how roles, responsibilities, and client interactions are performed during the case management process.
2.3.7. Case Study Method
The case study method was applied at three facilities providing services to people with disabilities to conduct in-depth analyses of the current status of records, the roles and tasks performed, and activities in case management, as well as to explore best practices and flexible models, and to explain some survey results. In addition, the study also involved two case management staff members (one at the Ward People's Committee and one at the social assistance center) to observe positive changes after the intervention experiment.
CHAPTER 3. CURRENT STATE OF CASE MANAGEMENT
FOR PEOPLE WITH DISABILITIES IN THE COMMUNITY
HO CHI MINH CITY
3.1. General situation regarding people with disabilities and related policies and services in Ho Chi Minh City
- As of July 2019, the total number of people with disabilities in the city was 62,554. Practical studies by several authors show that people with disabilities need assistance in all aspects of life, from monthly financial support, health insurance, medical examinations and treatment, policy counseling, assistance services and procedures, resources, health care counseling, equipment support, capital support, business and production counseling, vocational training, education, life skills training, social needs such as participation in social groups, recreational activities, counseling, psychological counseling, legal counseling, part-time care services, day care, full-time home care, and centralized care... This necessitates a diverse system of programs and services to meet these needs.
- During the period 2014-2020, the city also had several programs focusing on supporting people with disabilities in employment, healthcare, access to public facilities, legal assistance, poverty reduction, and social welfare. According to a report by the Ho Chi Minh City Department of Labor, War Invalids and Social Affairs, there are still many limitations in supporting people with disabilities in practice. The city also has a fairly diverse network of public facilities assisting different target groups. However, the number and accessibility of people with disabilities in the community to such facilities, units, and programs remain an unassessed gap.
- Regarding the workforce providing social work services, there are currently approximately 5,000 people in the system of People's Committees at all levels, public and private institutions, and mass organizations. The major challenge for Ho Chi Minh City is the regulation on downsizing the workforce while the responsibilities, pressures, and number of beneficiaries are large. According to the author's survey, 31.8% of the community-based disability management staff have not received social work training, and 62.3% have not received in-depth training in disability management. Up to 82.6% manage multiple target groups or take on other responsibilities.
3.2. Current status of case management implementation for people with disabilities in the community
3.2.1. Current status of the implementation of case management roles for people with disabilities in the community.
Management staff rarely or infrequently perform the roles (Consultant, Mean = 1.84; Advocate, Mean = 1.88; Coordinator, Mean = 1.94; Educator, Mean = 1.96; Facilitator, Mean = 2.15; Connector, Mean = 2.38). Only the resource mobilization role is performed at a normal level by staff, with the highest Mean = 2.88.
3.2.2. Current situation of staff implementing case management processes and tasks with people with disabilities in the community.
Most tasks in the steps of the disability management process are being performed infrequently (Receiving cases and building relationships with people with disabilities, average score = 2.07; Gathering information and assessing the needs of people with disabilities, average score = 2.45; Developing care and assistance plans for people with disabilities, average score = 2.21; Implementing care and assistance plans for people with disabilities, average score = 2.07; Notably, monitoring, supervising, and evaluating services and assistance has the lowest performance rate, average score = 1.96; Closing and post-case follow-up, average score = 2.2).
Besides the task of creating case files with initial information (essentially disability assessment files and later benefit payment lists) which was performed at a normal level (Average score = 2.71), other administrative tasks were performed infrequently or rarely (Using tools and forms in the process had the lowest average score = 1.81; Recording information and progress, average score = 2.12; Archiving, average score = 2.38; Reporting results periodically, average score = 2.38; Sharing information with consent, average score = 2.41; Maintaining file and information confidentiality, average score = 2.57).
The general overview of the process of managing the lives of people with disabilities in the community within the system of People's Committees at all levels is as follows:
|
The Ward People's Committee collects information and compiles files for people with disabilities, surveys and assesses their needs. Then, the Ward People's Committee compiles the files and sends them to the District Department of Labor, War Invalids and Social Affairs. Based on the criteria in the files as stipulated, the Department of Labor, War Invalids and Social Affairs submits them to the District People's Committee for the issuance of subsidy decisions. Monthly, based on the approved list of beneficiaries, the Department of Labor, War Invalids and Social Affairs prints out the files and sends them to the Ward for signing and distribution. If the person with a disability is in difficulty, the officer will deliver the subsidy to their home. In practice, there is inspection and supervision, usually done quarterly. During this period, the Ward is assigned to manage and update information on income, living conditions, etc. At the end of the year, the District/County sends an inspection team, mainly focusing on the list and subsidy payment system. In wards, communes, and towns, there is a dedicated Labor, War Invalids and Social Affairs officer (usually a Culture and Social Affairs officer) who manages many beneficiaries, including people with disabilities. In residential areas and villages, there are community support volunteers. These volunteers may be neighborhood group leaders, volunteers specializing in poverty reduction, children's issues, and population matters, but there is no clear distinction between them and volunteers specializing in people with disabilities. At the district level, there is one social welfare officer in charge of general policies for target groups. To date, Ho Chi Minh City has not yet defined job titles for social workers, social workers, or community work volunteers. |
3.2.3. Correlation testing in the implementation of case management with people with disabilities in the community.
The data analysis results show that the progress of the steps is highly correlated with each other, with values ranging from 0.543 to 0.683 at a 99% confidence level.
3.3. Factors influencing case management for people with disabilities in the community
3.3.1. Testing the factor rotation matrix of the influencing factors model
The factors influencing the management of people with disabilities in the community have Cronbach Alpha values ranging from (0.717 to 0.831) ≥ 0.6, and the adjusted variable-total correlation coefficients of the observed variables all meet the requirements (≥ 0.3). Therefore, all 30 component variables are eligible for inclusion in the EFA analysis.
KMO coefficient = 0.859 > 0.5. Bartlett test: Satisfactory (Sig = 0.000 < 0.05). Eigenvalues: Stopped at 5 factors. The influencing factors form a model with 5 groups of influencing factors and 29 observed variables that meet the requirements, except for the variable (facilities, support units with the capacity to mobilize resources) which was excluded from the model, with a loading coefficient < 0.05.
The five influencing factors model, explored based on self-assessments by community health workers, includes: Strengths and abilities of people with disabilities; Awareness and involvement of family and community; Legal policies; Support facilities and units; and Professional competence of community health workers.
3.3.2. Factors influencing the strengths and abilities of people with disabilities
Factors related to the strengths and abilities of people with disabilities were assessed at levels of strong and very strong influence (Identifying one's own strengths, average score = 4.07; Having willpower and motivation, average score = 4.08; Understanding one's own rights, average score = 4.18; Actively participating in cooperation had the highest level of influence, average score = 4.24).
3.3.3. Factors related to awareness, family and community involvement
On the family side, the factors assessed as having a strong influence include: Capacity to care for and assist people with disabilities at home (Mean score = 3.90); Understanding of policies, laws, programs, and support resources (Mean score = 4.07); Understanding of the rights of people with disabilities and having responsibility towards them (Mean score = 4.12); Actively participating and cooperating with staff (Mean score = 4.07).
From the community perspective, the strongly influencing factors include: Facilitating the participation of people with disabilities in community life (Mean score = 3.74); Proactively fulfilling responsibilities towards people with disabilities (Mean score = 4.02); Understanding the rights of people with disabilities (Mean score = 4.03); Actively participating as a resource for assistance (Mean score = 4.06).
3.3.4. Factors influencing legal policies
Factors assessed as having a strong impact include: Specific guidance and support tools (Mean = 3.70); diverse programs and services tailored to the needs of people with disabilities (Mean = 3.76); penalties and incentives in the work of the implementing team (Mean = 3.88); adequate support policies for people with disabilities (Mean = 3.96); specific policies regarding the position, role, responsibilities, and coordination mechanisms of the implementing team (Mean = 3.98); and adequate social security policies for the implementing team (Mean = 4.16).
3.3.5. Factors related to infrastructure and support units
- Factors assessed as having a very strong impact include: Facilities with sufficient professionally trained staff in workplace management for people with disabilities (average score = 4.21); Leaders prioritizing meeting the needs of people with disabilities (average score = 4.33); Leaders possessing knowledge of workplace management for people with disabilities (average score = 4.36).
- Factors assessed as having a strong impact include: Leadership commitment in directing the organization, implementation, and regular evaluation of disability management work (Average score = 3.86); Leadership understanding and responsibility in implementing the rights of people with disabilities (Average score = 3.97); Facilities with the capacity for collaboration and a network for referral and cooperation (Average score = 3.99).
3.3.6. Factors related to the professional competence of case managers
Based on subjective assessments, community health workers believe that the following professional competency factors strongly influence community health management for people with disabilities: Adherence to professional ethics and principles in community health management for people with disabilities (average score = 3.65); Professional social work qualifications (average score = 3.75); Understanding of people with disabilities (average score = 3.79); Skills in community health management for people with disabilities (average score = 3.95); and especially, knowledge related to community health management for people with disabilities has the strongest influence (average score = 4.02).
Assessing the correlation between professional expertise, occupation, and employee performance management.
Occupational factors
- The type of unit (A1) employees are working in also correlates positively with the extent to which employees are implementing their roles (r = 0.151) and the management process (r = 0.149) at a 99% significance level.
- The number of staff assigned to manage (A7) is inversely correlated with the level of performance of roles and management processes, with negative correlation coefficients of r = 0.119 and r = 0.109 respectively, at a 95% significance level.
Professional factors
- The factor of being trained in HR management (A5) has the strongest impact with a positive correlation coefficient with the level of employee performance in roles (TB1, r= 0.394) and HR management process (TB2, r= 0.374) at a 99% significance level.
- The factor of social work training (A4) also has a positive correlation with the performance of roles and the implementation of the management process by staff, with r-coefficients of 0.177 and 0.15 respectively, at a 99% significance level.
CHAPTER 4. TRAINING SOLUTIONS TO ENHANCE THE CAPACITY OF STAFF MANAGING CASES FOR PERSONS WITH DISABILITIES
4.1. Needs for capacity building training
All knowledge areas are assessed as absolutely essential, specifically as follows:
- The specialized knowledge areas related to community-based management of people with disabilities (G11-G18) were assessed by the surveyors with fairly diverse average scores (4.32 ≤ µ ≤ 4.76), with knowledge of evidence-based practice models (G16) having the highest average score (µ = 4.76).
- Knowledge of tasks related to the management process for people with disabilities (G19-G115) was assessed as relatively evenly as completely necessary (4.47 ≤ µ ≤ 4.71). Monitoring, supervision, and evaluation (G113) was assessed as the most necessary (µ = 4.71).
- The knowledge block regarding skills (G116-G121) was assessed as absolutely essential at various average scores (4.31 ≤ µ ≤ 4.75), with linking/connecting, coordinating, and transmitting skills (G118) receiving the highest rating (µ = 4.75).
- Regarding knowledge related to attitudes, professional ethics, and principles when working with people with disabilities (G122), it was also assessed as completely necessary (µ= 4.23).
4.1.2. Level of training
The survey respondents' training needs varied widely, ranging from short-term supplementary courses to professional training programs. Of these, 1-2 week courses were the most popular choice, with over half of respondents (50.9%).
4.1.3. Training duration
In terms of time schedules, respondents preferred weekend classes the most (75%), followed by weekday classes in 1-3 day sessions (63.7%).
4.1.4. Training methods
Nearly 82% of respondents chose traditional, classroom-based training, while 81% opted for on-site training with instructors.
4.2. Experimental intervention program
Theoretical basisBased on educational principles regarding the relationship between knowledge, skills, and attitudes [UNESCO, 2014]
Practical basis:Based on survey results, the performance of community health workers in their roles, processes, and tasks in community health management with people with disabilities is still quite limited. Influencing factors also indicate a strong correlation between professional training in social work and community health management and the performance of community health workers.
4.3. Experimental Results
4.3.1. Results before and after training
Measurements of understanding and confidence in implementation show a significant change in results after training, specifically as follows:
The roles staff play in the process of managing and treating people with disabilities in the community.
- Understanding of all roles increased significantly, with average scores ranging from 3.67 to 3.80, rated as good/well-informed. The increase ranged from 0.63 to 1 point, with the facilitating role showing the highest increase.
- The level of confidence in performing the roles also improved significantly. All roles were rated at an average score ranging from 3.50 to 3.63, indicating a fairly confident ability to perform independently. The increase ranged from 0.74 to 0.97 points, with the facilitating role showing the most significant improvement.
Tasks in the process of managing and treating people with disabilities in the community.
- Participants' understanding of the management tasks showed a clear positive change, with average scores ranging from 3.73 to 3.93, assessed as having a good level of knowledge. The increase ranged from 0.86 to 1.03 points, with the task of implementing care and assistance plans showing the most improvement.
- The average score for confidence in performing tasks ranged from 3.60 to 3.83, indicating a fairly high level of confidence in performing tasks independently. The increase ranged from 0.87 to 1.13 points, with the task of developing care and assistance plans showing the most significant improvement.
Skills in case management with people with disabilities in the community.
- The level of understanding in all self-assessed skills was rated as good, with average scores ranging from 3.77 to 3.87. This represents an increase of 1.06-1.17 points, with the most significant improvements seen in skills related to networking, referral, service coordination, and resource management.
- Participants' confidence levels changed significantly, with average scores ranging from 3.73 to 3.80, indicating a high level of self-confidence. The increase was 1.01 to 1.22 points, with the most noticeable changes observed in note-taking, reporting, and archiving skills (using forms).
The experimental results also showed a significant reduction in standard deviation across all aspects. This indicates that the differences among participants in terms of understanding and confidence levels have decreased, meaning there is greater uniformity among participants.
4.3.2. Case observation results
The individual guidance and supervision measures after training resulted in the following changes in the practical work of the project management staff:
Case 1(Male, 36 years old, civil servant in the Department of Culture and Social Affairs)
- There is a separate log for each case, with additional notes on the client's other needs, and cross-evaluation and information gathering from more sources have begun.
- Apply relationship-building skills with clients in a more systematic and calculated way, considering each communication situation.
- Performing specific activities in a wider range of roles than before: Educator, resource organizer, personal support person, network connector.
- A shift in thinking about service delivery: The idea of a paid service segment for people with disabilities who can afford it.
Second case(Female, 26 years old, homeroom teacher for autistic children)
Observations during the process of a facility management staff member working with a newly admitted child with disabilities at the Center (November 2019 - April 2020) revealed the following progress:
- Step 1 (receiving the case and building a professional therapeutic relationship with the person with disabilities and their family): The therapist has learned how to converse and communicate in a friendly atmosphere by smiling, expressing concern, and showing empathy towards the child and their family.
- Step 2 (Information gathering and assessment of needs for care and assistance for people with disabilities): Utilize listening skills and gather information from multiple sources, not only student records but also by meeting with clients, families, stakeholders, visiting family residences, filling out information forms, creating client profiles, and archiving information collection forms.
- Step 3 (Developing a care and support plan): Together with the other teachers, discuss with the family to agree on activities and responsibilities for each party to develop a weekly and monthly plan.
- Step 4 (Implementing the care and support plan): Together with the teacher, organize intervention and support activities for the child from an individual perspective, with the participation of other group members and other departments involved in teaching, care, health check-ups, therapy for the child, counseling for the child and family, and communication in the community.
- Step 5 (monitoring, evaluation, assessment): Each month, together with the other teachers, there will be an assessment of what has been accomplished and what has not been completed, discussions with the management (Center leadership), the children's families, and adjustments to the plan as needed.
- Due to the observation period of 6 months, the observation results at step 6 (case completion and follow-up) are not yet available.
CONCLUSIONS AND RECOMMENDATIONS
1. Conclusion
People with disabilities constitute a target group, clients with unique physiological, psychological, emotional, and social characteristics. Each individual has different needs, and therefore requires services and support tailored to each individual. Research shows that integrated management, especially integrated management in social work, is an effective and appropriate operational method for comprehensively managing all support services for a specific client with multiple needs. Overall, research indicates that with the roles and responsibilities within the integrated management process, integrated management staff can meet the needs of people with disabilities in the community.
In Vietnam, case management for people with disabilities has been institutionalized by state regulations since 2015 and recently guided for application to all target groups. Research on case management for people with disabilities in the community in Ho Chi Minh City shows that the implementation process by case managers in the community has some good models and methods, but also certain limitations. Regarding the roles demonstrating professional social work skills, case managers have partially fulfilled the role of mobilizing resources and have some good methods in mobilizing resources from natural networks (family, neighbors, etc.) and experts. They have also successfully facilitated access to some assistance policies for people with disabilities. However, some core roles of case managers, such as connectors, coordinators, and facilitators of social and community life, remain quite unclear. Similarly, educational or advisory roles, which are common roles for school administrators, are less frequently performed.
The study shows that disability management staff have, to some extent, performed some tasks and activities in the disability management process for people with disabilities, such as creating benefit payment files, collecting information on disability, health, education, livelihood, employment, or supporting people with disabilities with social policies or assisting them in participating in holidays and festivals. However, the professional tasks and activities of disability management are still largely unsatisfactory and rarely carried out, such as building relationships with clients, collecting information and assessing needs, especially needs in terms of social, relationship, psychological, emotional, and life skills aspects. Planning and implementation of plans are also infrequent. Monitoring and supervision mainly focus on the list of eligible beneficiaries and payment schemes. The steps and tasks in the process are closely interconnected. When a step or task is not performed well in one stage, it will affect the remaining steps in the disability management process.
The limited performance of staff in managing and assisting people with disabilities in the community is also related to difficulties and challenges arising from themselves, policies, people with disabilities, their families, the community, and the institutions where they work. One of the prominent difficulties and challenges is the unclear job position, the semi-specialized or multi-tasking nature of their work, as well as the lack of professional capacity among staff in managing and assisting people with disabilities in the community.
The process of managing cases with people with disabilities in the community is influenced by many factors. This study explored a model of strongly influencing factors, comprising five groups of factors with strong and very strong influence on the effectiveness of case management for people with disabilities in the community: Awareness and involvement of families and the community; Strengths and abilities of people with disabilities; Relevant legal and policy frameworks; Leadership and capacity at the grassroots level; and Professional competence of case management staff. Among these, the professional competence of case management staff appeared to be the most influential group of factors.
Based on research findings regarding the current state of case management for people with disabilities in the community, and considering training needs and the existing workforce, an experimental program was implemented, including training courses and post-training supervision, to enhance the professional capacity of case management staff in the community. The results showed improvements based on participants' self-assessments and case observations, reflected in their awareness, knowledge, and confidence in performing their roles, tasks, and skills in case management for people with disabilities. Furthermore, post-training supervision revealed positive changes in the trainees' performance of specific roles, tasks, and activities when managing cases with people with disabilities in the community. Thus, a training approach combining training, guidance, and supervision will be effective in improving the capacity of case management staff in the community.
2. Proposed solutions
In theory and practice, people with disabilities are a unique customer group, each with different characteristics and support needs depending on their disability type. Therefore, community-based support management (CSR) needs to be individualized and diverse. To enhance the effectiveness and professionalism of CSR management for people with disabilities in the community, a comprehensive set of solutions from multiple perspectives and stakeholders has been proposed.
2.1. Improving mechanisms and policies and increasing the capacity for law enforcement.
- Regarding Circular 01/2015/TT-LĐTBXH and Circular 02/2020/TT-LĐTBXH of the Ministry of Labour, Invalids and Social Affairs on the management of beneficiaries, including people with disabilities, it is necessary to study the feasibility and practical application in localities to make appropriate adjustments and updates. In addition, guidance, training, and monitoring during implementation should be promoted.
- Develop and issue regulations and procedures for inter-sectoral coordination among health, education, and justice sectors, clearly defining the roles of stakeholders and identifying and affirming the role of the team leader for the project management staff, giving them a specific position in the implementation process.
- Integrate social work-oriented childcare management into national and local programs and policies to promote this approach not only in centralized care facilities but also throughout the community.
- Continue to develop the network of collaborators, social workers, and social workers in both quantity and quality through human resource training and policy mechanisms to create a crucial human resource pool for implementing social work services in general and for carrying out interdisciplinary management for people with disabilities in particular.
- It is necessary to develop appropriate policies and allowance systems for officials, employees, and collaborators working in social assistance for people with disabilities to attract a high-quality workforce.
- Create mechanisms for socialization to enable non-public institutions to participate in providing public services, including healthcare for people with disabilities, with exemplary models.
2.2. Developing a network of service providers and units.
- Develop diverse types of services to meet the needs of people with disabilities in the community through the internal resources of the facility and especially within the network of service providers.
- Establish and network existing addresses, coordination processes, referral systems, and responsible units from social welfare institutions, other social work/social organizations, and local authorities to create a richer service resource at the local level. Focus on systematizing databases and promoting information to increase accessibility for people with disabilities and their families.
- Enhance service quality through the specialization of healthcare management activities via a trained workforce with specialized job positions, supporting each target group, including people with disabilities, and ensuring long-term job stability for those performing the work.
- Strengthen management through professionalization of case records, tools, forms, and operational activities to professionalize support services and meet the needs of people with disabilities accurately and adequately.
- Strengthen the service delivery network with the participation of various types of support facilities and units outside the local government system and public institutions.
2.3. Enhancing the capacity of the team implementing community health management for people with disabilities through specialized and appropriate training programs.and flexible
- Develop diverse forms of training and training programs in coordination with service providers and support units, based on labor market forecasts in the social services sector, national programs and projects, and specific orders from localities, such as short-term courses and longer-term programs to award certificates and diplomas, focusing on in-depth training and creating a specialized workforce.
- Promote training methods that combine theory, classroom practice, and fieldwork at the facility. Build a system of experienced local instructors to provide practical training and enhance the capacity of the school's management team.
- Increase the amount of practical training in the curriculum, alongside equipping participants with knowledge, skills, and professional ethics in managing and assisting people with disabilities in the community.
- Training needs to be conducted with interdisciplinary teams (labor, social affairs, and welfare officials, doctors, physiotherapists, judicial and education officials, etc., at the local level) to create a shared understanding and consensus in operational work.
2.5.Changing perceptions and increasing the participation of people with disabilities.
- Promote consultation, build trust, provide motivation, and uncover the hidden potential of people with disabilities.
- Changing perceptions through training and communication about the rights of persons with disabilities, legal policies, and equipping them with independent living skills and self-defense abilities.
- Encourage the participation and self-determination of people with disabilities when staff perform roles, tasks, and activities in the process of managing cases with people with disabilities in the community.
- Promote the establishment and maintenance of self-help teams and clubs so that people with disabilities can share, encourage, and support each other in life, creating consensus and a common voice for people with disabilities. Community management staff play a catalytic role, supporting the formation and operation of these groups.
2.6.Communication, raising awareness, and promoting the participation of families and communities.
- Conduct extensive awareness campaigns about the rights of people with disabilities, the system of policies and programs to assist them, the responsibilities of the community, the benefits to the community when the lives of people with disabilities are improved and they have opportunities for social integration, the history and national values, and the community values when assisting people in difficult circumstances, social support services, and ways to assist and communicate with people with disabilities in daily life within the community.
- Utilize various forms of communication and advocacy, such as organizing quizzes and awarding prizes related to specific topics; connect with healthcare, rehabilitation, nutrition, and psychological counseling experts in presentations, talks, training sessions, and community activities on prevention, early detection, early intervention, nutrition, self-care, and support for people with disabilities; use newspapers, radio, and social media channels of resident groups and neighborhoods to share information about the difficult circumstances of people with disabilities and their specific needs for assistance in the area, highlighting inspiring examples of resilient people with disabilities, and showcasing role models in the community who support people with disabilities.
- Facilitate community participation and the management of disability by applying a resource-based community development model to connect local resources in assisting and managing disability. Neighbors, friends, family leaders, etc., are both relevant stakeholders and a natural, informal network to support disability in various aspects: human resources, material support, relationships, and emotional encouragement.
- Strengthen the capacity of family members to help them support people with disabilities so they can care for themselves and live independently, while equipping them with skills in emotional management, changing perceptions, identifying abilities and strengths, and increasing the participation and respect for the voices of family members with disabilities.
- Providing feedback and sharing personal and family experiences in assisting people with disabilities through clubs, groups, and community activities is the best way to continuously improve services, change the culture of receiving social services, and improve access to services and assistance. Members participating in these groups can consult and connect with families in similar circumstances to share difficulties, increase the value of families in the community, and find appropriate and effective solutions for people with disabilities and their family members.
3. Limitations of the Thesis
Within the limitations of its scope and capabilities, this dissertation still has three major shortcomings:
The firstThe feedback and evaluation channels from people with disabilities as beneficiaries of services and assistance are limited, mainly relying on PVS (Personal Support Services). Therefore, self-assessment information from community health workers may still contain subjective elements. However, community health workers are the ones directly involved, so their role is extremely important. This research approaches the issue from the perspective of the practitioners themselves, reflecting on their own experiences using the principle of self-reflection in social work practice.Monday,The questionnaire survey method failed to determine the overall sample size, and the position of community health workers in their interactions with people with disabilities in the community remains unclear. The level of professional social work training and specific training in community health management among respondents was not high, leading to some unfamiliar terminology in the questionnaire. The influencing factors were assessed from the subjective perspective of the community health workers. Respondents' self-assessments may increase or decrease when using a scoring method (Siemsen, Roth & Oliveira, 2010), or some responses may be dishonest (Evans, 1985). Such limitations may affect reliability. The thesis also failed to establish a regression model to establish causal relationships, thereby failing to identify strong influencing factors with greater scientific rigor. The online survey method may be affected by several factors such as a lack of personnel to guide questionnaires or answer questions. However, thanks to this format, the survey area covers 23 out of 24 districts and counties, and brings diversity from the organizations and units participating in the survey. The distribution of questionnaires still accounts for the majority, ensuring control and support during the questionnaire-answering process. Furthermore, the thesis overcomes some limitations by using various qualitative research methods (in-depth interviews, focus groups, case studies, and experimental interventions with multiple target groups) to allow for analysis, supplementation, and comparison.Tuesday,The experiment involved a short period of time and lacked comparative analysis with a control group, therefore the reliability of the capacity-building training measures for case management staff is somewhat limited. Results related to descriptive statistics with small sample sizes have limited reliability (Gogtav, 2010). This thesis addresses this by incorporating a qualitative research method (observing cases with two employees of different demographic characteristics working in different types of organizations) to verify changes in the practical application of case management after the experiment.
LIST OF AUTHOR'S WORKS RELATED TO THE THESIS
Author:ussh
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